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Published on: March 14, 2013
Determinants of regional cerebral oxygenation in children with sleep-disordered breathing
Maha Abou Khadra1, Keith McConnell, Rhonda VanDyke
1Department of Pediatrics, Cairo University, Cairo, Egypt.
Insights
Pediatric sleep-disordered breathing negatively impacts cerebral oxygenation, affecting cognition. Factors like REM sleep and oxygen saturation improve it, while NREM sleep and arousal index worsen it.
Area of Science:
- Pediatric Sleep Medicine
- Neuroscience
- Respiratory Physiology
Background:
- Pediatric sleep-disordered breathing (SDB) is linked to neurocognitive deficits.
- Current understanding of factors influencing cognitive outcomes in pediatric SDB is limited.
- Disease severity poorly correlates with functional outcomes, highlighting knowledge gaps.
Purpose of the Study:
- Identify SDB-related parameters affecting pediatric cerebral oxygenation.
- Develop a predictive model for pediatric cerebral oxygenation using identified parameters and demographics.
Main Methods:
- Polysomnography with continuous cerebral oxygenation and blood pressure monitoring in 92 children (controls, primary snoring, obstructive sleep apnea).
- Analysis of covariance used to correlate blood pressure, sleep parameters, and demographics with regional cerebral oxygenation.
- Cerebral oxygenation index derived by referencing sleep measurements to wakefulness measurements to account for anatomic variability.
Main Results:
- Mean arterial pressure, rapid eye movement (REM) sleep, female sex, age, and oxygen saturation positively influenced cerebral oxygenation.
- Arousal index and non-REM (NREM) sleep negatively affected cerebral oxygenation.
- A predictive model for the index of cerebral oxygenation was established.
Conclusions:
- Increased mean arterial pressure, age, oxygen saturation, and REM sleep enhance cerebral oxygenation.
- Sleep-disordered breathing, male sex, arousal index, and NREM sleep reduce cerebral oxygenation.
- The developed model may elucidate variability in cognitive function among children with SDB.
Rationale:
An association between neurocognitive deficits and pediatric sleep-disordered breathing has been suggested; however, weak correlations between disease severity and functional outcomes underscore the lack of knowledge regarding factors modulating cognitive morbidity of sleep-disordered breathing.
Objectives:
To identify the parameters affected by sleep-disordered breathing that modulate cerebral oxygenation, an important determinant of cognition. A further objective was to use these parameters with demographic data to develop a predictive statistical model of pediatric cerebral oxygenation.
Methods:
Ninety-two children (14 control subjects, 32 with primary snoring, and 46 with obstructive sleep apnea) underwent polysomnography with continuous monitoring of cerebral oxygenation and blood pressure. Analysis of covariance was used to relate the blood pressure, sleep diagnostic parameters, and demographic characteristics to regional cerebral oxygenation.
Measurements And Main Results:
To account for anatomic variability, an index of cerebral oxygenation during sleep was derived by referencing the measurement obtained during sleep to that obtained during wakefulness. In a repeated measures model predicting the index of cerebral oxygenation, mean arterial pressure, rapid eye movement (REM) sleep, female sex, age, and oxygen saturation had a positive effect on cerebral oxygenation levels, whereas arousal index and non-REM (NREM) sleep had a negative effect.
Conclusions:
Increasing mean arterial pressure, age, oxygen saturation, and REM sleep augment cerebral oxygenation, while sleep-disordered breathing, male sex, arousal index, and NREM sleep diminish it. The proposed model may explain the sources of variability in cognitive function of children with sleep-disordered breathing.
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